1. Pilot to Improve & Maintain Quality End of Life Care in Residential Care Homes & Domiciliary Care providers

2. Background The End of Life Care Strategy (DH, 2008) identified high incidences of inappropriate admissions to hospital from care homes at the end of life and highlighted a need for end of life care training for care home staff The Six Steps to Success programme for Care Homes is a workshop style training programme developed by the Greater Manchester and Cheshire Cancer Network, the Merseyside and Cheshire Cancer Network and the Cumbria and Lancashire End of Life Care Network with support from the National End of Life Care Programme

3. Background Six Steps enables care homes to implement the structured organisational change required to deliver the best end of life care and is based on The Route to Success in End of Life Care – achieving quality in care homes (2010)

4. Six Steps at LOROS LOROS have previously run 2 cohorts of the Six Steps programme Self reported data suggests positive outcomes from the training Feedback from GP mentors was that they could see a difference in care homes that had taken part in the programme

5. Building on the success of Six Steps The current project aims to build on the success of Six Steps to allow for individual and organisational recognition We also plan to have a more robust system in place to capture key data and outcome measures In conjunction with St Christopher's Hospice we aim to demonstrate that the project is both scalable and sustainable

6. Aims To improve end of life care for frail older people across LLR – Equip staff with the skills and confidence to care for people at the end of life Benefits may include: – increased proportion of residents dying in their preferred place of care – reduction in inappropriate acute hospital admissions

7. Bronze level – year one Part 1 - Foundations in Palliative Care for Care Homes training: – 1-3 senior carers and the manager from each care provider – 5 day course: principles of end of life care; communication; pain and symptom control; loss and grief; dementia awareness – Option for accreditation at QCF Level 2 ‘Award in Awareness of End of Life Care’ for those who attend – Potential to map the contents to the Care Certificate (requirement from April 2015)

8. Bronze level – year one cont’d Part 2 –Six Steps: – Taught programme, in conjunction with practice development visits/support – The manager at each site will be supported to implement three main systems: Monthly review register taken to the GSF primary care meeting to aid coordination and communication with GPs and DNs Care Plan for the last days of life Reflective de-briefing sessions following a death

9. Bronze level – year one cont’d Each site will construct a portfolio of evidence to demonstrate the learning they have achieved within each of the six steps An audit would be undertaken of the year’s deceased residents notes including hospital admissions/deaths; ACP discussions; use of a care plan for the last days of life; and resuscitation decisions. This audit is then on-going To maintain Bronze status the organisation will submit annually: – Evidence of ongoing attendance at the Primary Care GSF meetings – A portfolio of reflective debriefing sessions undertaken following the death of each resident, along with action plans and evidence of implementation. – Attendance of new staff on an end of life induction programme – Audit data - hospital admissions/deaths; ACP discussions; use of a care plan for the last days of life; DNA-CPR decisions